Overall Health Survey
How confident are you filling out medical forms by yourself?
Original source question text
How confident are you filling out medical forms by yourself?
From which existing source was this question derived?
Brief Health Literacy Screen (BHLS)
Year of Original Source
2004
Brief Description
The Brief Health Literacy Screen (BHLS) is a three-item health literacy measure that can be administered in a minute or less. The BHLS, developed in 2004, has been used widely in clinical and research settings.
URL
https://www.ncbi.nlm.nih.gov/pubmed/15343421
How often do you have someone help you read health-related materials?
Original source question text
How often do you have someone help you read hospital materials?
From which existing source was this question derived?
Brief Health Literacy Screen (BHLS)
Year of Original Source
2004
Brief Description
The Brief Health Literacy Screen (BHLS) is a three-item health literacy measure that can be administered in a minute or less. The BHLS, developed in 2004, has been used widely in clinical and research settings.
URL
https://www.ncbi.nlm.nih.gov/pubmed/15343421
How often do you have problems learning about your medical condition because of difficulty understanding written information?
Original source question text
How often do you have problems learning about your medical condition because of difficulty understanding written information?
From which existing source was this question derived?
Brief Health Literacy Screen (BHLS)
Year of Original Source
2004
Brief Description
The Brief Health Literacy Screen (BHLS) is a three-item health literacy measure that can be administered in a minute or less. The BHLS, developed in 2004, has been used widely in clinical and research settings.
URL
https://www.ncbi.nlm.nih.gov/pubmed/15343421
In general, would you say your health is:
Original source question text
In general, would you say your health is:
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
In general, would you say your quality of life is:
Original source question text
In general, would you say your quality of life is:
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
In general, how would you rate your physical health?
Original source question text
In general, how would you rate your physical health?
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
In general, how would you rate your mental health, including your mood and your ability to think?
Original source question text
In general, how would you rate your mental health, including your mood and your ability to think?
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
In general, how would you rate your satisfaction with your social activities and relationships?
Original source question text
In general, how would you rate your satisfaction with your social activities and relationships?
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?
Original source question text
To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
In the past 7 days, how would you rate your pain on average?
Original source question text
In the past 7 days, how would you rate your pain on average?
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
In the past 7 days, how would you rate your fatigue?
Original source question text
In the past 7 days, how would you rate your fatigue on average?
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
In general, please rate how well you carry out your usual social roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)
Original source question text
In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious, depressed, or irritable?
Original source question text
In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious, depressed, or irritable?
From which existing source was this question derived?
PROMIS Global Health short form
Year of Original Source
2009
Brief Description
The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short-Form, developed in 2009, is a ten-item self-report measure that assesses overall physical and mental health in adults and children.
URL
http://www.healthmeasures.net/explore-measurement-systems/promis
Have your menstrual periods stopped permanently?
Original source question text
Have your menstrual periods stopped permanently?
From which existing source was this question derived?
California Teachers Study
Year of Original Source
1995
Brief Description
Since 1995, the California Teachers Study has investigated the incidence and risk factors of breast cancer among more than 130,000 female California teachers and administrators. The longitudinal cohort study is designed to determine the incidence and potential risk factors for breast and other cancers.
URL
https://www.calteachersstudy.org/
options and variations noted below:
- Are you currently pregnant?
- Original source question text: Not applicable
- From which existing source was this question derived? This question was developed specifically for use within the All of Us Research Program
- Year of Original Source: Not applicable
- Brief Description: Not applicable
- URL: Not applicable
- Why did your periods stop?
- Original source question text: Why did your periods stop?
- From which existing source was this question derived? California Teachers Study
- Year of Original Source: 1995
- Brief Description: Since 1995, the California Teachers Study has investigated the incidence and risk factors of breast cancer among more than 130,000 female California teachers and administrators. The longitudinal cohort study is designed to determine the incidence and potential risk factors for breast and other cancers.
- URL: https://www.calteachersstudy.org/
- Have you ever had a hysterectomy (that is, surgery to remove your uterus or womb)?If yes, age at surgery?
- Original source question text: Have you ever had a hysterectomy (that is, surgery to remove your uterus or womb)?
- From which existing source was this question derived? California Teachers Study
- Year of Original Source: 1995
- Brief Description: Since 1995, the California Teachers Study has investigated the incidence and risk factors of breast cancer among more than 130,000 female California teachers and administrators. The longitudinal cohort study is designed to determine the incidence and potential risk factors for breast and other cancers.
- URL: https://www.calteachersstudy.org/
- Have you ever had an ovary removed? If yes, age at surgery?
- Original source question text: Have you ever had an ovary removed?
- From which existing source was this question derived? California Teachers Study
- Year of Original Source: 1995
- Brief Description: Since 1995, the California Teachers Study has investigated the incidence and risk factors of breast cancer among more than 130,000 female California teachers and administrators. The longitudinal cohort study is designed to determine the incidence and potential risk factors for breast and other cancers.
- URL: https://www.calteachersstudy.org/
Have you had a transplant of any type?
Original source question text
Had a transplant such as organ, tissue, or bone marrow?
From which existing source was this question derived?
AABB Blood Donor History Questionnaire
Year of Original Source
1992
Brief Description
The AABB Blood Donor History Questionnaire (DHQ), also referred to as the Uniform Donor History Questionnaire (UDHQ), was developed by the AABB (formerly American Association of Blood Banks) for use by blood centers to meet regulatory requirements for screening potential blood donors. It evaluates prospective donors’ history against known blood safety risks following FDA regulations/recommendations and AABB Standards. Version 2.0 (2016) is the current version of the questionnaire.
URL
http://www.aabb.org/tm/questionnaires/Pages/dhqaabb.aspx
options and variations noted below:
- If yes, please check all that apply. Date requested for each item selected.
- Original source question text: Not applicable
- From which existing source was this question derived? This question was developed specifically for use within the All of Us Research Program
- Year of Original Source:
- Brief Description: Not applicable
- URL: Not applicable
Have you traveled outside of the country within the past 6 month?
Original source question text
In the past three years, have you: Been outside the United States or Canada?
From which existing source was this question derived?
AABB Blood Donor History Questionnaire
Year of Original Source
1992
Brief Description
The AABB Blood Donor History Questionnaire (DHQ), also referred to as the Uniform Donor History Questionnaire (UDHQ), was developed by the AABB (formerly American Association of Blood Banks) for use by blood centers to meet regulatory requirements for screening potential blood donors. It evaluates prospective donors’ history against known blood safety risks following FDA regulations/recommendations and AABB Standards. Version 2.0 (2016) is the current version of the questionnaire.
URL
http://www.aabb.org/tm/questionnaires/Pages/dhqaabb.aspx
options and variations noted below:
- Where?
- Original source question text: Not applicable
- From which existing source was this question derived? This question was developed specifically for use within the All of Us Research Program
- Year of Original Source:
- Brief Description: Not applicable
- URL: Not applicable
- How long were you there? Enter number of days.
- Original source question text: Not applicable
- From which existing source was this question derived? This question was developed specifically for use within the All of Us Research Program
- Year of Original Source:
- Brief Description: Not applicable
- URL: Not applicable
